To protect players, NFL needs 'culture change,' doctors say

WASHINGTON — — The NFL needs a "culture change" -- and perhaps major modifications to helmets, injury-reporting procedures and practice rules -- to better protect players from head injuries, two prominent neurosurgeons said Wednesday.

"We're at that tipping point where there is probably going to have to be an enormous culture change that occurs that will happen over years," Richard G. Ellenbogen, co-chairman of the NFL's Medical Committee on Head, Neck and Spine, told reporters after a one-day, league-financed educational conference.

"The youth athletes are looking to the professionals as role models, and the professionals now realize if they don't do it right, the kids aren't going to do it right," said Ellenbogen, a University of Washington professor.

Ellenbogen and Hunt Batjer, who is also a neurological surgeon, were interviewed after a brain injury conference attended by NFL commissioner Roger Goodell and representatives of the NFL Players Association and most of the 32 teams. The conference was organized and hosted by Johns Hopkins Medicine.

Ellenbogen and Batjer were named co-chairs of the committee in March. The previous chairmen resigned in November after one was criticized by members of Congress for questioning research into a linkage between repeated NFL hits and long-term brain damage.

Speaking to the conference in private, Goodell emphasized that Ellenbogen and Batjer are new and would operate independently of the league.

"We have completely reformulated the committee," Goodell said, according to written remarks distributed after he spoke. "We are supporting them and giving them full independence and transparency to do their work. And they would not have it any other way."

The conference, held at a downtown hotel, was closed to the media. Scientists were made available to reporters after it ended.

The NFL has toughened its procedures governing when players may return from concussions. In December, the league notified teams that players suffering concussions must not return to games or practice that day, and must be given a neurological test.

But conference participants said there remained serious gaps in knowledge about brain injuries' links to football.

Johns Hopkins psychiatrist Constantine Lyketsos said it's important to study the effect of multiple hits. While a single tackle might only sporadically cause a concussion, he said the accumulation of hits -- hundreds in a season by a player -- might have an effect.

In recent years, University of North Carolina football players have been wearing high-tech helmets that measure the jolt of contact.

As research continues, Ellenbogen and Batjer suggested some changes that might be in store:

Injury-reporting procedures might be revamped. Batjer said injured players reflexively resist coming out of games so as not to let down their teams. "There are tremendous disincentives to report," he said. "So I think our challenge with the NFLPA is to work to break down some of those cultural barriers and create incentives in the opposite way. There could even be financial incentives to report" injuries.

The neurosurgeons indicated it was premature to detail how such incentives might work.

"What we learned was that the NFL Players Association was open to all remedies," Ellenbogen said.

Helmets could be altered. " I would not be surprised if we take a huge leap in the technology in the next decade that is beyond what we could have imagined," Ellenbogen said.

Contact could be restricted during practices. "That was discussed at several times during the meeting," Batjer said. "These are things that could be implemented that would not affect conditioning," he said.